Does Compliance with Antibiotic Prophylaxis in Pediatric Simple Appendicitis Matter?

• Published in: The Journal of surgical research Vol. 216; pp. 1 - 8
• Main Authors: Mueck, Krislynn M., MD, MPH, Putnam, Luke R., MD, MS, Anderson, Kathryn T., MD, MPH, Lally, Kevin P., MD, Tsao, KuoJen, MD, Kao, Lillian S., MD, MS
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-08-2017
• Subjects: Adolescent; Anti-Bacterial Agents - therapeutic use; Antibiotic Prophylaxis - standards; Antibiotic Prophylaxis - statistics & numerical data; Antibiotic stewardship; Appendectomy; Appendicitis - surgery; Appendicitis antibiotic prophylaxis; Cefepime; Cephalosporins - therapeutic use; Child; Child, Preschool; Drug Therapy, Combination; Female; Follow-Up Studies; Guideline Adherence - statistics & numerical data; Humans; Infant; Infant, Newborn; Logistic Models; Male; Metronidazole - therapeutic use; Pediatric simple appendicitis; Penicillanic Acid - analogs & derivatives; Penicillanic Acid - therapeutic use; Piperacillin - therapeutic use; Piperacillin, Tazobactam Drug Combination; Practice Guidelines as Topic; Preoperative Care - methods; Preoperative Care - standards; Preoperative Care - statistics & numerical data; Protocol compliance; Retrospective Studies; Surgery; Surgical site infection; Surgical Wound Infection - epidemiology; Surgical Wound Infection - prevention & control; Treatment Outcome; Pediatric Simple Appendicitis; Appendicitis Antibiotic Prophylaxis; Surgical Site Infection; Antibiotic Stewardship; Protocol Compliance; Surgical site infection; Pediatric simple appendicitis; Protocol compliance; Antibiotic stewardship; Appendicitis antibiotic prophylaxis
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1016/j.jss.2017.04.002

Abstract Background: Institutional protocols for pre-incisional antibiotic prophylaxis can standardize care and improve outcomes. However, challenges remain in compliance with such protocols for urgent or emergent operations. We hypothesized that compliance with an institutional protocol for antibiotic prophylaxis for appendectomy for appendicitis in pediatric patients results in reduced surgical site infections (SSIs) after simple appendectomy. Methods: This retrospective study assessed all pediatric patients (≤ 18 years) who underwent appendectomy for confirmed simple appendicitis at a tertiary children’s hospital between 2012 and 2015. Demographic, admission, and outcome data were recorded. Compliance with the protocol was assessed. Univariate analyses were performed to identify factors associated with any SSI and protocol non-compliance. Results: Overall compliance with antibiotic prophylaxis occurred in 590/697 patients (85%). Compliance was high with timing (91%), spectrum (95%), and protocol recommended drug (87%). Admission antibiotics alone were administered in 65 patients (9%), pre-incisional antibiotics alone in 254 patients (36%), and both in 378 patients (55%). Patients included in the analysis received a median of 2 (range 1- 6) doses of antibiotics preoperatively. Ten patients (1.4%) developed an SSI. Only receipt of any antibiotics within an hour of incision was associated with decreased odds of SSI (OR 0.22, 95% CI 0.06-0.87). No factors were associated with non-compliance. Conclusions: An institutional appendicitis protocol yields high compliance with prophylactic antibiotic administration and associated low SSI rates, but at a cost of antibiotic over-administration. Further efforts are necessary to sustain compliance while also practicing appropriate antibiotic stewardship.